Provider Demographics
NPI:1609858752
Name:CUSTOM MOBILITY INC
Entity Type:Organization
Organization Name:CUSTOM MOBILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-539-8119
Mailing Address - Street 1:7199 BRYAN DAIRY ROAD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1502
Mailing Address - Country:US
Mailing Address - Phone:727-539-8119
Mailing Address - Fax:727-539-6372
Practice Address - Street 1:7199 BRYAN DAIRY ROAD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1502
Practice Address - Country:US
Practice Address - Phone:727-539-8119
Practice Address - Fax:727-539-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62 CERTIFICATE 8809332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0389290001Medicare ID - Type Unspecified